Neurofeedback

Neurofeedback is a noninvasive form of neurotherapy that utilizes EEG-based biofeedback. What this means is that the equipment is reading brain waves in real-time while prompting the brain to make slight changes to those brain waves. These slight changes accumulate over time leading to lasting changes in how the brain functions and essentially to how it communicates with our mind and body.

The Brain 101

It is important to have a baseline understanding of how the brain functions to have a better grasp of the magnitude of the impact of neurofeedback. The brain communicates and functions via chemicals (neurotransmitters) and electrical signals (brain waves). A combination of dysregulated production of neurotransmitters and dysrhythmia in brain waves give rise to mental health conditions and disorders.

Since the birth of psychiatric medications in the 1950s, the go-to brain treatment, when talk therapy didn’t suffice, has been introducing artificial neurotransmitters or chemicals that stimulate an artificial mode of functioning. Artificial meaning that once the medication runs out, the brain will go back to its baseline functioning.

Although the world of psychiatry has provided a lot of immediate relief to those suffering from chronic mental illness, there are side effects and downfalls to medication. Some of which are:

• The impact on other organs
• The heightening of symptoms or further mental decline upon discontinuing medications
• Chemical dependency on the medications
• Medications do not help give rise to actual changes in how the brain functions

Neurofeedback therapy was pioneered between the 1950s and 60s yet has been slow to become a go-to treatment. Although it is evidenced based, meaning clinicians and clients can both read hard data demonstrating a change in brain waves, perhaps the lack of instant gratification or relief that medication provides has hampered its rise as a primary treatment option.

Nonetheless, with the growing concern from clients and parents of children who are being suggested psychotropic medications, neurofeedback is gaining momentum, more acceptance, and is being sought after as a non-medication-based form of treatment. Neurofeedback therapy does not have the side effects as medication does. (Side effects will be discussed later.)

Additionally, the changes that result from neurofeedback are lasting changes to brain functioning. Of course, environmental and lifestyle factors can impact the extent and magnitude of these changes.

Neurofeedback is like taking your brain to the gym. Similar to what happens when our muscles train at the gym, it takes time and consistency to start seeing muscle definition and feel the effects of stronger and bigger muscles. Additionally, lifestyle habits will also impact the rate at which we see the physical results from the gym. The same principles can be applied to the impact of neurofeedback on the brain.

Similar to our physical muscles, our brain also requires good fuel and an adequate amount of sleep for repair. Your neurofeedback clinician should do a lifestyle assessment before beginning treatment to create a plan that will help you receive optimal results.

As briefly mentioned, neurofeedback helps the brain to function better and even heal by giving the brain real-time feedback to adjust brain wave production. There are four main brain waves that the equipment our practice uses will focus on: Alpha, Beta, Theta, and Delta.

Brain waves span out into a vast network of neural pathways that then over or under-activate different regions of the brain. Each of the brain waves has specific functions and impacts not only how our brain functions, but also our mental state and how and what we think.

• Alpha directs creativity, visualization, and relaxation.
• Beta controls concentration, cognition, and alertness.
• Theta manages meditation, memory, and intuition.
• Delta oversees sleep, detached awareness, and healing.

You may be beginning to see that dysrhythmias in the frequency and amplitude of these waves can easily give rise to and/or elevate the symptoms of a variety of mental health issues such as ADHD, Anxiety, OCD, Autism, Depression, PTSD, and traumatic brain injuries to name a few.

Like a domino effect, the disruption in brain waves and their patterns then impacts how different regions of the brain function. That will then dictate the manifestation of mental illness symptoms.

Change is accomplished via two routes. Throughout the neurofeedback session, your brain is receiving cues (via auditory and visual changes). These cues signal to the brain a reward when the brain waves being trained are at optimal frequency and amplitude.

Your brain is constantly learning throughout the session how it needs to change its functioning to receive more rewards and be in a homeostatic status. The brain strives to be in homeostasis because that state requires the least amount of energy. Think of it as being on cruise control. Even when homeostasis is not ideal for the person, the pre-existing neural pathways are so ingrained that the brain does not know any other way to be. This leads to the second route of change.

Neuroplasticity is the concept that the brain, with the right consistent stimulus and reward, can forge new connections and can change. The brain will grow and reorganize neural networks which are the pathways that send communication throughout the brain.

Although neuroplasticity is at its peak in early development, the brain has the capability to reorganize and make new connections regardless of age. Consistent neurofeedback sessions provide the brain with the ideal conditions for it to want to make new connections and give way to lasting changes.

A wide range of people can benefit from neurofeedback. It is a brain training program that can provide relief from symptoms, healing, and help you attain levels of success you did not think were possible. Often people with chronic mental illness will turn to neurofeedback because they feel stuck in talk therapy.

Additionally, high-level professionals and athletes will also use neurofeedback as a way to level up their mental game. Here is a brief overview of some of the brain-based conditions that neurofeedback can help treat.

• Mood Disorders Such as Anxiety, Depression, OCD, Panic, DTD, and PTSD Neurofeedback has been found to help clients feel calmer, safer, and more present (Tsalali et al, 2019). By training the reduction of excessive beta waves and increasing alpha waves, the brain can more appropriately assess situations, therefore, decreasing an overly anxious response. Depression requires a slightly different protocol where alpha is decreased and beta is increased. A recent study of clients with MDD (major depressive disorder) found that a one-hour/week neurofeedback training showed a decrease in depressive symptoms just after six weeks (Wang et al, 2016).
• Developmental Disorders Such as Autism, ADHD, PANS/PANDAS The brains of those with developmental disorders are wired differently which manifests characteristics typical to those disorders. Neurofeedback would give the brain the necessary prompts to help it rewire via neuroplasticity and thus reduce the common symptoms associated with those conditions. ADHD is one of the most studied conditions. Studies by Duric et al. (2012) and Meisel et al. (2013) demonstrated that 30-40 sessions of a Theta-Beta ratio protocol was just as effective as methylphenidate (a stimulant) to decrease inattentiveness and hyperactivity, plus was shown to increase academic performance.
• Sleep Disorders Sleep deprivation makes it hard for the brain to retain new information from the day as well as impairs cognitive functioning throughout the day. Whether it’s difficulty falling asleep or staying asleep, there are specific protocols that can help strengthen the theta waves before bedtime which can lead to sustained REM sleep. Neurofeedback has been shown to increase the total amount of sleep time, time in REM sleep, and decreased period of waking throughout the night (Cortoos et al., 2009)
• Neurological Issues and Brain Injuries Like Stroke, Tinnitus, Parkinson’s, and TBIs Although neurofeedback cannot repair the physical damage caused by these conditions, it can help strengthen the brain to create new neural pathways that will lend to better brain functioning.Keller (2001) studied a group of 21 people who had suffered from a TBI. The group of ten who received 10 neurofeedback sessions in two weeks had a significant improvement in attention when compared to the control group.
• Peak Performance
  
  Professional athletes, high-level executives, high-performing professionals, and creatives are all looking to attain a competitive mental edge over their competition. Neurofeedback provides the tools for the brain to function more precisely, quickly, and effectively so that less time is wasted on overanalyzing and stress management. Gruzlier (2014) reviewed twenty-three controlled studies that demonstrated neurofeedback provided measurable gains in intellectual performance, well-being, longer sustained attention, implicit procedural memory (the ability to do everyday tasks with less mental effort), recognition memory, complex psychomotor skills, overall memory, reaction time, faster decision making, and greater ability to manage thoughts, emotions, and reactions.

Like training at the gym, some people may see results faster than others. The brain takes time to grow, reorganize, and create new pathways. The goal or pre-existing condition can also dictate the length of time before results are noticeable.

On average, most clients begin to notice and experience changes between sessions 10-20. To cement changes, 30-40 sessions are the typical treatment length. For more complicated conditions such as Autism, other developmental delays, TBIs, and trauma-related conditions a longer length of treatment will be needed.

Since we don’t live in a vacuum and cannot have a completely controlled environment, day-to-day situations and stressors can impact results. It may happen that after consulting with your neurofeedback clinician, the treatment protocol is changed to attend to the pressing circumstance at hand before returning to the prior protocol. Neurofeedback training is flexible in that it can meet the client where they are in the present moment.

Is It Safe? Are There Side Effects?

Neurofeedback is non-invasive and safe for clients of any age. Even clients who are nonverbal and low functioning can receive and benefit from neurofeedback. There is no electrical current being sent to the brain, like in other forms of brain-based therapies like LENS, TMS, or tDCS.

Only 1-3% of clients, have reported very mild side effects of slight brain fog or feeling mentally tired after a neurofeedback session. Any symptoms resolve quickly. If these symptoms do arise, protocols can be adjusted to minimize side effects. With the convenience of using a remote neurofeedback program, you and your clinician will set up the ideal time of day for your training to mitigate potential side effects.

Here at Orange County Christian Counseling, we understand the importance of time as well as the desire to achieve results. The equipment (headband and single electrode) that we use can provide neurofeedback training at home. No more scrambling to fit in office visits three times per week. Depending on the client’s treatment goals, ideal training times will be determined with your neurofeedback clinician.

Since the equipment is compact and portable, you can train for 20 minutes whenever and wherever is most ideal in your schedule. The training program and your secure client profile are run through an app, which is accessible to phones or tablets. Your clinician will have live access to your training session and can provide immediate feedback if needed.

From your client portal, you can view your session results as well as see how your brain waves are adjusting to training. What is also exciting is that Orange County clients do not have to worry about having to be within driving distance of one of our offices. The remote capability allows clients anywhere within the state to be able to access this service. A recent study validates the effectiveness of the specific remote neurofeedback training system we use in treating the aforementioned brain conditions (Whitehead et al, 2022).

Another aspect of our neurofeedback service that is unique is that your neurofeedback clinician is also a licensed psychotherapist. We are excited to have one of our psychotherapists, Kristy De Leon, MA, PsyD, LMFT offer neurofeedback. This is key in achieving results because having a psychotherapist as your neurofeedback clinician allows for richer conversations regarding your goals, and obstacles, and creates realistic coping strategies that will expedite and sustain changes.

Additionally, by having a mental health expert overseeing your program, your level of care and treatment will be more personalized and detailed. Unlike going to a non-mental health expert for neurofeedback, here your entire life story is considered when goal setting and treatment planning. You will receive strategies that will not only boost your training session outcomes but will also be lifelong skill sets.

How Can I Get Started with Neurofeedback?

We begin with a thorough two-part assessment to make sure you are a good candidate for neurofeedback. As previously mentioned, neurofeedback is like taking your brain to the gym. All studies on the effectiveness and efficacy of neurofeedback show that consistently training three times a week provided optimal results. The length of treatment depends upon the severity and the client’s goals. Commitment to treatment is an important aspect of achieving the desired results.

The first part of the assessment will gather relevant information and history regarding what has made you seek out neurofeedback.  Your neurofeedback clinician will do a deep dive into personal history along with gaining an understanding as to what is happening in the present that is contributing to undesired symptoms.

The second part of the assessment will be a combination of questionnaires plus single electrode EEG readings of the five main brain regions: front, central, left, right, and back. The assessment will conclude with reviewing your brain wave maps and graphs and creating a treatment plan. Treatment plans are flexible and can accommodate what is happening in real life.

Contact our reception team to schedule a consultation appointment.

References

Cortoos et al. (2009). “An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary Insomnia.” Applied Psychophysiology and Biofeedback. DOI:10.1007/s10484-009-9116-z

Duric et al. (2012). “Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports.” BMC Psychiatry. DOI:10.1186/1471-244X-12-107

Gruzelier (2014). “EEG-neurofeedback for optimising performance. I: A review of cognitive and affective outcome in healthy participants.” Neuroscience & Biological Reviews. DOI: 10.1016/j.neubiorev.2013.09.015

Keller (2000). “Neurofeedback Therapy of Attention Deficits in Patients with Traumatic Brain Injury.” Journal of Neurotherapy.

DOI: 10.1300/J184v05n01_03

Meisel et al. (2013). “Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up.” Biological Psychology. DOI:10.1016/j.biopsycho.2013.04.015

Tsalati, Sidiropoulos, & Bamidis. (2019). “Effective Neurofeedback applications in anxiety and attention symptomatology in adolescents.” L’Encéphale (French  journal of General Psychiatry (Clinical Psychiatry and Psychopharmacology). DOI:10.1016/j.encep.2019.04.041

Wang et al. (2016). “The efficacy of neurofeedback among patients with major depressive disorder: Preliminary study.” Neuroregulation. DOI:10.15540/nr.3.3.127

Whitehead, Neeman, & Doniger. (2022). “Preliminary Real-World Evidence Supporting the Efficacy of a Remote Neurofeedback System in Improving Mental Health: Retrospective Single-Group Pretest-Posttest Study.” JMIR Formative Research. DOI:10.2196/35636